More and more patients research their health online. (Darren Staples/Reuters)It’s time for a second opinion about medical Googlers.
As readers of the Well blog will recall, one of the liveliest discussions to take place here centered around a doctor’s disdain for medical Googlers. New York orthopedist Dr. Scott Haig wrote an essay in Time magazine complaining about a class of patients he called “brainsuckers” — those patients who research their symptoms, illness and doctors on the Web before seeking treatment.
Now another doctor has weighed in on the debate. Dr. Rahul K. Parikh, a San Francisco pediatrician, has written his own essay for Salon.com and notes that physicians like Dr. Haig who reject the Googlers do so at their peril.
“The Internet is a disruptive innovation that has overturned the status quo. It has leveled the playing field between expert and novice — in this case, doctor and patient. While some doctors … may find that challenge threatening to their status as an expert, the Web is now providing the kind of information doctors need to be aware of if we want to continue to be good at our job, and the kind of trends that can help patients be smarter and healthier.”
Dr. Parikh notes that Dr. Haig’s original article reflects the angst of many doctors about the Internet. He cites a 2001 study of doctors that showed barely half of them encouraged their patients to go online, and 80 percent actually warned them against doing so. But it’s simply bad business to force patients to venture onto the Internet alone, he says.
“When patients do venture online themselves, they can sink into a swamp of outdated medical studies, confront a lot of misinformation, and risk creating a rift in the doctor-patient relationship.”
Dr. Parikh says it is a lesson pediatricians have already learned. He notes that doctors weren’t paying attention in the late ’90s, when patients were just beginning to go online en masse and theories about vaccines and autism were first circulating.
“We weren’t paying much attention until parents started to refuse vaccines. When we looked, we realized that many parents were exposed to story after story on autism Web sites and in chat rooms about the dangers of vaccines. That echo chamber of opinion became a reality despite our best efforts to prove otherwise…. Would things have been different if we had engaged our patients from the get-go by providing them with alternative Web sites, scrutinizing and rebutting anti-vaccine “science,” or posting studies demonstrating vaccine safety in the public domain? I would answer, emphatically, yes.”
Instead of rejecting medical Googlers, doctors would be well advised to guide them to reputable sites from respected medical institutions like the Mayo Clinic or other sites with which they are familiar.
“Doctors need to know about them so that along with a prescription for a medication or lab test, they can give patients a prescription for information that informs, empowers and helps patients be smarter and healthier.”
Dr. Haig hasn’t returned e-mails seeking comment.
For the full essay in Salon, click here. For links to Dr. Haig’s original essay, as well as the lively discussion it generated on the Well blog, click here.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
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From 1 to 25 of 93 Comments
When a physician discourages a patient from researching the patient’s medical condition, the physician seems to be thinking of his or her own interests, not those of the patient.
Certainly, the Internet is an ocean of misinformation, and many people have difficulty sifting through the clearest of that information. A family member who is a physician does not complain of patients who are armed with information and ask questions, but he does say more of them could create problems for his appointment schedule.
Still, when a patient cares enough to research his or her medical condition, it seems likely he or she is also likely to take better care treating the condition. Also, that patient may encourage the physician to rely on more for his or her continuing medical education than just the self-interested promotion of drug company representatives. And that information may ultimately helps the patient better steer through the maze of medical care.
It seems to me that, while sometimes inconveniencing physicians, patients with more medical information are more likely to get better medical care. And shouldn’t medical care be about helping patients, not physicians? The physicians are already nicely compensated.
— LewisHow do you educate a doctor? In other words…
Suppose I, as a patient, have read a scholarly book or an article that diverges from the treatment guidance that my physician is giving me. I’d like him to read it and consider it, give me some feedback. But I don’t want to come on like a crackpot, and I want to be respectful of the many other demands on his time. What are some tips for asking?
— David ThroopTPP - I’m not usually one to nitpick, but is this a typo? You seem to say that 30% of doctors encourange patients to go online AND warn them against doing so. I assume the 50% number is right.
“He cites a 2001 study of doctors that showed barely half of them encouraged their patients to go online, and 80 percent actually warned them against doing so.”
— Posted by Consumer
[NOTE: This comment was originally posted in the #1 spot but because of a technical glitch was moved here.]
To address Comment from Consumer, above: “You seem to say that 30% of doctors encourange patients to go online AND warn them against doing so.”
Sure. It works like this: “If you want to learn more about this, I know you’ll probably think about researching it on the Internet. I want to caution you: if you just start Googling randomly, you’ll scare yourself half to death. There’s a lot of misinformation out there, a lot of bad science, and a lot of anecdotal claims from people with no evidence to back up what they’re saying. So be careful. If you want to read further, check out a reputable website like PubMed or WebMD.com.”
This is both a recommendation (check out WebMD) and a warning (don’t just consult Dr. Google). It’s the sort of thing I tell patients all the time.
— CherylBased on the irrefutable evidence from the countless discussion groups and hip and knee arthroplasty Websites offering support to patients with unanswered questions or problems following HRA or TKA surgery , there are more than a few orthopedic surgeons performing shoddy HRA surgery on their patients that they evidently, not only abjectly failed to meet the demands of their obligation to ensure the well being of above all other considerations, but these surgeons have gone the extra mile by exhibiting an absence of empathy especially toward patients with perioperative complications.
In case anyone was wondering, the Jewish survivors of the WWII Nazi death and concentration camps didn’t re-define pure evil as the Nazis or the inhumane treatment their captors inflicted on them but rather, they re-defined pure evil as the absence of empathy the AMERICANS exhibited during the 13 years we knew about the camps and what was going on inside and never lifted so much as a finger to stop or prevent what was going on inside.
Following the end of WWII a reporter asked Einstein how he felt about future generations of Germans having to bear the stigma of the Nazis to which Einstein immediately and sternly replied, “I would not be too quick to assume that the character of man differs much from one geographic location to another.”
Therefore, as you review the numerous HRA and TKA surgery patient support and discussion Websites, keep in mind the patients posting perioperative complications following HRA are seeking answers on the INTERNET rather than in their orthopedic surgeons office. Surgeons moaning about the evils of the Web and that the information pertaining to HRA surgery is at best unreliable and possibly harmful to the well being of patients, should consider visiting one of the evil discussion boards before condemning them—in other words, surgeons might find several of their patients in the numerous discussion boards discussing what a hack their surgeon was and whether these guys went to a non-continent medical school in the Bahamas.
Bob Rayburn
— bob rayburnNightmare Orthopedics
As one of the many people who commented on your November 19th posting about Dr. Haig and his derisive attitude toward patients who “google,” I was happy to read Dr. Parikh’s Salon.com rebuttal. But, while Dr. Parikh is much more respectful of medical googlers than was Dr. Haig, when he asserts that physicians should guide their patients to reputable websites like the Mayo Clinic’s, I believe he is implying that patients can safely trust most of what they read on these reputable websites — without question.
It is very important to note that the savviest researchers — doctors and patients alike — know that they must ALWAYS evaluate the information they find online (or in medical journals), very critically. This is especially important, in light of the fact that several medical research institutions (and some researchers themselves) have been found to have financial ties to the pharmaceutical companies whose medications they are studying. Sadly, even the Mayo Clinic’s researchers may not be immune from this practice.
For instance, a visit to the Integrity in Science Database of the Center for Science in the Public Interest in Washington, DC, (http://www.cspinet.org/cgi-bin/integrity.cgi) reveals the names of nineteen Mayo Clinic researchers who have received funds from pharmaceutical companies, such as Pfizer, Bayer, Johnson & Johnson, Bristol-Myers Squibb, Abbott, Amgen and Merck, to name a few.
I spoke recently with Merrill Goozner, Director of this respected database project. He pointed out that financial ties do not in themselves say anything about the quality of a person’s research. However, he noted that “one must closely scrutinize the quality of the research to see if it is influenced by the financial arrangement. Study after study has shown that industry-funded research, and/or researchers with ties to industry, are much more likely to come up with results that favor the interests of their financial sponsors.”
So, while I am not saying that information on these websites that Dr. Parikh recommends is biased — even if some of the researchers have financial ties — I am saying that those of us who regularly consult the Internet for much of our medical information would be advised NOT to blindly trust ANY of the information we find — even on sites that are considered to be most reputable.
Julia Schopick
— Julia Schopickhttp://www.HonestMedicine.com
Recently, a young woman called the ER because she was worried about lower abdominal pain. After calling twice, she presented to the ED (at 4am!) convinced it was a cyst causing infertility because that’s what she had read online. Result: it was her PERIOD. (Infertility, as tragic as it is, does not equal medical emergency)
I wish everyone knew how to critically evaluate information. I wish everyone understood statistics. I wish everyone understood that medicine is by no means a static or perfect science. I wish everyone would stop thinking they know better than professionals who have studied medicine for the better part of a decade or more, but also stop expecting doctors to have all the answers. They are one of many resources, including the internet, when it comes to health.
When you go online and look up a condition or symptom, what you’ll find is a laundry list of things to look out for: headache, dizziness, nausea, dry mouth, etc. All of these have the unfortunate luck of being symptoms for every disease known to humankind and also being normal symptoms of a normal body. But many people these days are convinced they have the latest fad disease they heard about on Dateline or they need the latest prescription for the disease-of-the-week that’s been given a new acronym that didn’t exist before. (RLS anyone?) The internet can be a useful tool. But in the wrong hands, it can contribute to either making a big deal out of nothing or smoke-screening what might actually be a serious condition. And now we have to trust doctors to interpret which it will be.
— buttercupI research because I have a long, complicated medical history and rarely respond happily and quickly, in a standard way, to the approaches suggested by docs for my health problems.
But in addition, I come to medical appointments informed and prepared and armed with info because I can’t afford to waste a minute. Most docs don’t take my insurance for consults, so I have to pay for them, and it’s very expensive. The one doc that does take it restricts me to one consult ever two months for my ongoing conditions.
I know I’m not alone. Doctors seem willfully clueless about how anxious the public–healthy or chronically ill–is about medical costs related to their services. I’ve had docs obsess stupidly over lab fees or prescription costs without even asking me the structure of my insurance coverage: in fact almost all labs they ever want to order are covered, and with some work (on my part, not the docs’) I can get scrips covered. It’s THEIR fees I can’t get covered. THEY are the big cost for me. But they don’t seem to want to see this. These guys charge $300 an hour–that’s pretty standard for a doc for complex illness in northern CA who doesn’t bill insurance and doesn’t belong to HMOs or PPOs.
If they want us to be less anxious and act slightly less controlling about appointments, they can make single-payer health care happen, so that we can relax about the money thing and focus on the reason we’re there.
And yes, docs could make single-payer happen. All they have to do is agree together to do it.
— kraftytrilobiteA well informed patient is a valuable asset to the “team”. By augmenting the keyboard exercise with a little extra legwork; ie. library, one should be equipped to enter into a productive discussion thereby enhancing the potential to streamline the overall diagnosis and treatment. Most of the physicians I interact with have responded in a positive manner to this approach. I for one want this particular team to win.
— Siladiumhttp://www.siladiumblog.com/
Every other day I Google “Type 1 diabetes” and hit the “News” button to keep up on the progress that is being made by various academic and commercial research facilities towards finding a cure for my condition. Much of the news consists of ‘fluff’ stories; they outline the life of a Type 1 diabetes sufferer, usually either a cute little kid or an athlete (never a normal, average adult - no sympathy value there) and then the article asks for donaitons to either the JDRF or the ADA or a local fundraiser in the near future. These aren’t the articles I’m looking for, but they are amusing. What I’m really hunting for are press releases from places like the University of Massachusetts (where I will get to be one of Dr. Faustmann’s lab rats), lists of upcoming Phase II and Phase III clinical trials, progress reports in blogs run by Type 1 diabetics who are sick and tired of being talked down to by their endocrinologists or handed the same old bull about ‘hope for a cure someday’. As I see it, I have been hoping for a cure form my endos for over 27 years and I’m tired of sitting around waiting for them to get off their duffs and do something other than prescribe me insulin and testing strips. There is a great deal of silent and unseen suffering on the part of those of us with chronic conditions and the Web is allowing us not only to share information about treatments and coping solutions that our endo might not even know about, but allows us to seek out health information as it becomes available via medical journals, press releases and company announcements. I asked my endo, on the last visit, whether anyone was doing anything for Type 1’s toward a cure and he said that other than the TEDDY studies (screening newborns who have a 1st-degree relative with Type 1 for the genetic defects that lead to the condition diabetes later in the child’s life) there wasn’t really anything going on as far as a real cure, just experiments.
People looking for specific medical info love the Web - as long as you verify the information you find with a phone call or a secondary source (and a reputable one - no New-Agey garbage), you can learn a great deal. I brought up several questions about products that were in the drug pipeline and asked if they were available long before my endo had ever heard of them. When they did recieve FDA approval, I was one of the first to receive them, because I knew enough to ask.
People need to stop equating doctors with gods - they are not all seeing and all knowing. They are human beings who are sometimes less informed than their patients, especially if their patients are willing to do some sleuthing on their own. I plan on volunteering for any Phase III trials I can find, and it doesn’t matter if it’s for a drug company or for a university lab.
— Ticked-Off Type 1To kraftytrilobite: I’m a physician (and a patient) with his own set of complex medical issues, and I’m certainly not going to argue with your medical googling. Whatever makes you a smarter, savvier consumer of medical services is a good idea in my book.
But I’d argue with a few of your points regarding fees and insurance coverage. We “obsess stupidly” over costs to patients because (most of us) aren’t “willfully clueless” about the anxiety that medical expenses bring. Conscientous doctors try to reduce their patients’ bills. No one who’s ever been a patient (and most of us - even physicians - have been patients at some point) is unaware that medical costs are tremendous. And it’s good that you’re aware about the details of what your insurnace covers or doesn’t cover, because most people aren’t. Many of my patients know only their plan’s name, not what’s covered or what hoops they have to jump through to get needed services covered.
And by the way, the obstacles to a single payer health care system aren’t the doctors. Most of us practice under, and are paid by, a de facto oligarchy of federal and corporate medical payors that arbitrarily dictate how much we’ll be reimbursed for a given service - much like a single payer health care system. And as a result, hospitals like mine actually lose money on hugely expensive cases like lifesaving complex vascular reconstructions. We don’t turn these patients away. We do our job, our patients go home, and the hospital’s bottom line happens to suffer - but believe or not, the hospital’s bottom line matters a lot less to us than the satisfaction that comes with saving lives.
I think you should keep your eyes wide open about the consequences of a ‘true’ single payer system, along the lines of the current English or Canadian systems. I’ll quote Claire Rayner from The Independent (London; 3/29/2001);
“I was working in a hospital as a cadet nurse at the time, and heard people talk, often with high emotion, of how marvellous it was to know that from now on we would all be cared for free by doctors from cradle to grave, and need never fear illness again….But to be truthful, it wasn’t long before that shiny new NHS slipped into bad habits as far as older people were concerned…
…More recently, there has been rising anger among older people and their families about the ageism that has continued in the NHS. People of 65- plus have been refused not only dialysis and kidney transplants, but also stroke rehabilitation, care in specialist coronary units after heart attack and - I kid you not - some arthritis units.”
It’s not doctors denying coverage in the UK, it’s a government-appointed committee that decides whether or not your health, or even your life, is worth the money.
Sorry for the long post, it’s just that I’m saddened to read these forums and see that physicians like myself have becomes lightning rods for much of the anger that people feel towards the health care system. Believe me, kraftytrilobite, it’s not like we can just wave our hands and make it right.
— BillThe Internet is a fabulous resource for information of all sorts, and clearly the medical profession is going to have to learn how to work with patients given the availability of information. It is now possible (for example) to find out if odd symptoms have anything to do with a new medication prescribed. Some physicians are overly concerned that if side-effects are known, they’re more likely to be experienced. It’s an attitude that is a trace patronizing at best, dangerous at worst.
I am living with HIV and have stories that could curl everyone’s hair: the podiatrist who mis-diagnosed a case of cellulitis in my ankle (a bacterial infection of the soft tissue) as gout; the drugs that left me with a severe case of pancreatitis, but no one told me what to expect (dehydration, nausea, etc.), so I suffered through it as an outpatient; even the initial physician I saw who wanted to treat an auto-immune disorder with large doses of prednisone (which is immuno-suppressive) knowing that I had just been diagnosed with HIV.
I have suffered equally, though, from well-meaning friends who have read about some new treatment on the Internet (or in a newspaper) that they are convinced will make my life better. There was one friend who seemed to specialize in finding out the worst possible scenario for any symptoms and then badgering me to find out more about her “diagnosis.” (To be fair, she did this with everyone, including herself.) She tried to talk me into taking a protein supplement based on an article in the paper that turned out to be little more than a reprinted press release from the maker, and the tests that the “article” touted had been conducted by physicians who had a connection to said maker of the supplement.
I use the Internet to supplement the information I get from my physicians on very specific issues. However, the sheer amount of information is overwhelming. In this way, the Internet is a double-edged sword; there is great potential for both good and bad to result from the information found.
All that said, if a patient truly feels so little confidence in a physician that they’re constantly seeking more information, I’d say the doctor-patient relationship needs some work, or else the patient should find a new doctor. And if a physician finds patients that seek out information on their own via the Internet completely intolerable, they’re going to have a hard time practicing medicine in the modern world. The internet hasn’t caused this problem, any more than it has caused the problem of identity theft. These kinds of tensions between patients and doctors are as old as the Hippocratic Oath.
From TPP — All very well stated. Thanks.
— DMHWell… I had one doctor tell me a few times in response to my questions that she was a “board-certified physician.” Which may have been true, but did not really answer my questions. Nor was I ever challenging her pedigree; I was only asking why the recommended procedure. (that same physician told me that her other patients did not ask so many questions, which was also not really an answer to my question)
And most specialists do not spend much time with patients.
Do doctors blog? Because all that people are looking for is information. And maybe a FAQ or two. We just want to see options. We want to know why. We also want to feel heard.
At some point she finally told me, “we don’t know. we err on the side of caution.” And since that is also what my web research was telling me, and I felt it to be true, I allowed the procedure without any further questions.
— susanThe tag line for one of the stores says “an educated consumer is our best customer.” Why this would not work well in medicine is beyond me. Granted there is much misinformation on the web, but there is also much valuable information. A patient who researches his condition is likely to be a better patient.
As an educator, it has been my experience that teachers who lack confidence in the material they teach are uncomfortable when students ask questions, and respond poorly. Could it be that the doctors who don’t like their patients to conduct their own research lack confidence in their work?
Science Editor
— SciEdhttp://www.polijam.com
Your Guide to News Around the Web
To The New York Times editorial staff:
(1) BLOGS do not belong on the same page with NEWS. Here you are with a blog, quoting Salon, and the basic ‘content’ is a discussion of OPINION between two doctors. Some of us expect better than this from the NYT.
(2) As to the topic being discussed, how about this -
November 10, 2006.
Clinicians reportdly prefer Google because it is easy to use and freely available. (Reuters)
Doctors use Google to diagnose disease: study
By Anna Salleh, ABC Science Online
It is not just patients who are frantically plugging their symptoms into Google to see what disease they might have, Australian researchers say doctors are doing it too.
Dr Hangwi Tang and Dr Jennifer Ng of the Princess Alexandra Hospital in Brisbane have reported their findings online in the British Medical Journal.
Dr Tang says the study was driven by personal curiosity after noticing how patients and doctors alike were using Google to diagnose difficult cases.
In one example, he had a patient whose father used the search engine to correctly diagnose that his son had the rare circulatory condition - Paget-von Schrötter syndrome.
Dr Tang and Dr Ng selected 26 difficult cases presented in the New England Journal of Medicine, including Cushing’s syndrome, Creutzfeldt-Jakob disease, encephalitis and cirrhosis.
They then plugged the symptoms of each case into the search engine to come up with a diagnosis.
— P. JenningsGood medical websites are out there; Googlers just have to use some common sense. In addition to WebMD.com and the Mayo Clinic site, I have found breastcancer.org to be very helpful. Much basic info, online sessions with well-qualified docs, immediate updates on latest research (with translation into simpler language as well), chat rooms, etc. I am sure there are comparable sites for other diseases. If not, there should be!
— LindaWell now a new issue has come up…of course doctors Google. But they have the training to discern between good info and bad info.
Even after many years of training, there is no way that a doctor has seen everything they might need to see in the wide world of medicine. That’s why it’s important to have a community of doctors to pull knowledge from. It’s also why they are required to have continuing education credits every year. You actually WANT your doctor to be willing to seek assistance when they need it.
— buttercupBill, you are right that many docs do know that costs are high and do try to help limit them.
What I meant to make clear was that my doc didn’t note that everyone’s plan is different, so our approach to dealing with my issues needs to be tailored to that.
Which is crazy. Because having everyone’s plan being different makes us all crazy.
Thus your comments on single-payer systems:
>>>I think you should keep your eyes wide open about the consequences of a ‘true’ single payer system, along the lines of the current English or Canadian systems
Anyone who reads bbc.com–and I recommend it, as they cover things American media including NYT never do–knows that the English system has been destroyed.
But I wasn’t looking there for a model. Perhaps France or Sweden? Some country that spends money on its people instead of on starting wars around the world.
>>People of 65- plus have been refused not only dialysis and kidney transplants, but also stroke rehabilitation
We already have this. My father might have survived his stroke last year had he received enough cutting-edge swallowing and respiratory therapy, as the neurologist had said he would require. But Medicare did not cover his staying at the facility where he could receive the therapies he needed, for long enough. Medicare caps on stays in acute and LTAC facilities are highly restrictive and unrealistic for the reality of many illnesses. Rationing already exists. We all (except VP Cheney) know that and have already experienced it.
>>Believe me, kraftytrilobite, it’s not like we can just wave our hands and make it right.
Bill, I’m not that naive. What I do know, tho, is that the AMA was powerful enough to stymie the establishment of Medicare for decades. Finally they agreed and Medicare began and now Medicare is the salvation of many specialists who could never support their offices on HMO reimbursement levels.
What I meant to imply I will now say more clearly: if docs got together they could make single-payer happen through political action. Yes, I know they’re all cats and ‘you can’t herd them’. But they’re capable of collective political action just like any other constituency if they see where their bread is buttered. (To mix metaphors even worse!) It’s just a matter of will, time, and money.
— kraftytrilobiteIf you go back and read the original article, the doctor was complaining about a patient with a personality disorder who crossed every line and used her google-obtained info to bludgeon the doctor. She even found the doctors home address and let him know it!
To simplify the article as Dr. Haig against educated patients is to misinform. He was writing about how some patients us the info as a weapon. He writes about other, informed patients whom he loves to treat.
The original article was about a patient’s misuse of information to shift power to herself and really wasn’t looking for care; she was looking for validation at the expense of the doctor.
Please stop pretending it was simply an arrogant doctor who wished to keep his patients ignorant to maintain all the power in the relationship. It slanders him and, by association, all of us in the medical community.
From TPP — I don’t agree that Dr. Haig indicates anywhere in the original essay that there are “other informed patients whom he loves to treat.” He likes nurses, because they trust doctors. He likes engineers, because they are logical and teachable, and they are “interested in how the doctor thinks about their problem.” If you read it, he doesn’t ever say he likes an informed patient; he says he wants patients who are teachable and trust his judgment as an expert.
— PatriciaInformation available via the internet is a wonderful tool, but without the training and ability to discriminate it can be a hindrance to a fluid and efficient dialogue between a patient and physician.
I am a 4th year medical student, preparing to become a physician this May. During this time I learned how to examine patients, what the typical and atypical presentations of common and deadly diseases may be and studied their respective treatments. These 4 years of studying, consisting of 7 days a week,/12-16 hours a day, and will be followed by a minimum of 4 more in residency training in a specialty of my choice. This involves the same schedule of non-stop reading, lectures, conferences, supervision, exams plus responsibility for patient care will deepen my knowledge and understanding of how diseases affect patients and how to treat them.
This leads to my next point: having access to medical information does not make anyone a medical doctor. The foundation of 8-10 years of medical school + residency is intended to train physicians how interpret patients’ symptoms and, based on evidence based medicine, treat the underlying disease. Its an art that, like many things takes a long time to master. Thinking that reading some web sites would make one knowledgeable on the level of a physician would be an error. It can however help patients become well informed about a diagnosis (or possible one), its complications and treatment. This can be a tremendous asset to any physician patient relationship. If it helps a patient be more involved and committed to improving their health, great!
I however would suggest a patient’s greatest expertise may lie in a very unique place no doctor could assume…. their bodies; namely disease symptoms, side effects of medications, lifestyle choices, personal and family medical history, records/labs from other providers and an honest communication regarding adherence to treatment plans and reasons for not doing so. If reading web sites helps inform patients about any aspect of that process, that’s great for everyone involved!!
Here are some thoughts on where the breakdown may begin between patient and physician:
1) patients: may assume knowing as much as the physician, may come across as telling the physician what to prescribe, may ask more questions than time permits thus reduce time for an exam/discussion, may be filled with misinformation which must be undone.
2) physician; can be pressed for time and become impatient, may not clearly communicate their goals for the appointment, may not wish to be questioned, may be unclear about what findings mean, may be exhausted from long hours/patient overload.
Any of these factors (or others I surely missed) can lead to a break down in communication. I think BOTH parties have responsibility to communicate their expectations regarding what they hope to achieve in the appointment. That is where the healing may begin. Expectations, however, must be realistic.
— Med StudentThis country has been injected with terror of single-payer systems because some of them, the British one in particular, were underfunded and poorly managed. We already pay the most money per person for health care than any other country. We just let a lot of that money go to duplicative paperwork, upper management salaries and benefits, stockholders, etc. It is the private insurance system that has failed us by giving us managed care like a single payer system but with high administrative costs and we still uninsure and underinsure millions. Because we are not all in the same boat, we don’t have the clout we would have to insist on changes we want to our systems; we have to be grateful and kowtow to the insurance companies that are willing to cover us or work with our employers. Follow the money. The physicians aren’t raking it in anymore, so who is? Take a good look at the financial picture of health insurance providers and pharmaceutical companies for a start. Look at who is financing campaigns and obligating our elected representatives. Turn off their “Harry and Louise” ads and look at the administrative costs for Medicare and compare them to those of the average health insurance provider and see the over 30% difference. All that wasted money could be reducing your premiums, adding services, and covering others who are left out in the cold now. It’s easy to run around screaming “socialized medicine” and get people to vote against their own financial self-interest, but we aren’t all fooled.
— –Econ gradkrafty #7, YES! And YES again and again! Please Tara, can you lead your next column with krafty’s post in capital letters? This cannot be repeated often enough. Doctors, are you listening?!
— vickiOh and Dr. Bill, #10, surely you know that the British NHS is the worst possible example of European nationalised health care for one very simple *political* reason: NHS used to be a fine system until the Thatcher government set about gutting as much of its funding as they possibly could. The NHS has been hobbled ever since. Oh, you know, kind of like the efforts of the current administration here to gut every federal governmental department responsible for public services, then when each department is crippled by lack of funding and can’t do its job, the politicos can say ‘Look! we told you the dysfunctional government was the problem!’ The same Tory economic ideology there and here. Yes, the militant free marketers in the UK and US really have been comparing notes for three decades on how to dismantle the public health and social service sectors. Funding for the health care sector in the UK is among the lowest in Europe. The NHS is *not* representative of successful European public health care systems on the continent. The need to critically evaluate information, in print or on the web, applies as much to our debates about comparative health care systems as it does to patients’ online research on medical treatments, drugs and disease.
— vickiI wonder what these MD anti-googlers would think
— Mr.radiotubeof my wife a Parkinson’s patient who is registered to
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i have just returned from the last in a long series of frustrating medical experiences. as a way of relaxing, i decided to spend the morning leisurely reading the new york times online–wanting very much to push the experience that my family and i had recently endured to the back of my mind. i couldn’t resist, however, reading the story about “medical googlers” realizing that by doing so i would be defeating my purpose of trying to relax.
sure enough–i’m pumped and primed to respond to the audacious opinion of the doctor who thinks it’s best for his patients NOT to be well-informed.
is there anyone who can say that medical care in the US is all that it should be? i’d like to meet the person who says “yes”.
my family’s recent experience took place in one of the country’s best hospitals. the doctor who finally took care of my family member’s problems was an expert and did his job well.
HOWEVER–most of the time spent by my family in the hospital was filled with miscommunication, no communication, errors in orders and more. i wish i could say that this was an unusual situation–it was not.
i’ve seen too many doctors, nurses and other health care providers in similiar situations over the last 20 years and instead of the situation getting better, it is getting markedly worse.
i’ve seen young doctors (residents and interns) whose faces are still somewhat freshly eager to “help people”–but already the lines of cynicism are developing. one case in particular in this last medical episode caused a young doctor who was trying to explain to my family how a test got cancelled inexplicably–and finally just shook his head.
what does this all have to do with the story of “medical googler”. it has everything to do with patients being as well-informed as possible–because sadly the patient and family do become a part of the medical team. it would be wonderful to simply put oneself in the hands of a caring, brilliant doctor — and leave the “driving” to the medical system.
very rarely is that possible.
two stories are illustrative of why medical googling is imperative for the patient.
medical speak is a foreign language–usually involving long latin words that are impossible to pronounce let alone understand. isn’t it better to have prepared yourself beforehand with what these words might be and mean.
in the last episode –i had googled what was suspected was wrong with my family member. as a result, i was able to understand why certain tests were being ordered, which test were most reliable and what the results would signal for treatment. knowing this information helped me have confidence in the doctor and helped my family to understand the situation. i didn’t by the way, flash around the four pages i had printed out from emedicine (a great site) to intimidate the doctor. i simply had the advantage of understanding the “medical speak” that was being thrown at my family.
second story. several years ago, my doctor prescribed a low dose blood pressure medicine. i had been taking the medicine for about two months, when i began to break out in weird rash on my lower legs. it didn’t itch and wasn’t uncomfortable-but it was spreading. one night i went online and studied lower leg rashes. i ran into all kinds of long words, horrifying photos, some nasty diagnoses but i persevered. i found the photo that looked like what i had, scrolled down and voila–rash caused by blood pressure medicine i was taking.
i made an appointment with my doctor the next day-together we went online in his office computer–he read-looked at my leg-looked at me and “said-hmmmmmmmmmmmm, that sure looks like what you have”. he changed the medicine, rash went away–blood pressure stable. he never once resisted our partnership in discovering this weird, rare reaction to this medicine. he’s a brilliant, kind doctor whom i trust implicitly to help with my health care–but he was grateful for the work i had done on the computer to help find out what was going on.
what doctor would be against that who has his or her patient’s wellbeing first and foremost.
i suggest that instead of doctor’s resisting considering their patients as partners in their health care issues–they spend whatever extra time they have–FIXING– a health system that is severely broken.
i’ve said too many times now–”if medicine were a business-it would be out of business”.
let’s stop complaining about the well-informed patient and start begging, urging anyone who will listen who can do something–to focus on getting the medical system back to where the phrase “do no harm” means something for every patient.
— cbwI have spent a year struggling with a detached retina. One thing I have learned is sometimes you only have a limited time to bring together your ailment and the best physician you can afford or use. Second opinions are good if there is time–there may not be and you may not get much from them, either. So, you better do some research if you are up to it. I had a surgeon resistant to outside data. In one instance, I brought in info on a govt program to create an artificial retina and he said, “At the meetings, no one ever attends the sessions on that.” Oh…I guess that was an answer. But to me, it was more of an answer about how he felt about me, if he respected me. One place the internet can really help is in after- care. They told me I had to be facedown 24 hrs a day after my first surgery–no exceptions, period. I sent away my dog–the light of my life–and he was killed by a car. Then researching, I learned many surgeons let the head come up 5 minutes out of every hour–one raising of the head does not ruin the surgery. I put up a website on this myself.
— Star